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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 X WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Todd and Lynn Hervas <br />Property Owner's Mailing Address: 6585 Dove Ct Mason OH 45040 <br />City State Zip <br />Property Site Address: 2898 Oak Lake Rd Webster <br />Contact's Telephone Number: 715-259-3257 <br />Contact's Email: northland001@centurytel.net <br />Legal Description of Property: Lot 13 CSM 6/276 <br />Section #: 20 Town #: 40 N Range #: 14 W Town of. Scott <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 18313 <br />Proposed Use of Structure/Addition: Screen porch/deck/garage .S % , 6 9 a ( j Y) <br />Anticipated Start Date: ASAP (Home/Cabin: Commercial Business: Bedroom; Deck: etc.) <br />Building Contractor: Northland Builders Inc Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONAS LISTED BELOW: <br />N 0 )l Q.S S "rj ,t Y� J-0 -44 S 6j law G fJ`- �/V tN Vi <br />S' SJGkba�.1 mvS�6'r- o�)-<,ri- s', �- <br />S (�{' ¢_,2� } �� L�✓�� ('e S�o fa..1'iar� ('e,C�v�e�nt%-�--►"���`r�s <br />�1 Q^�'e'<' Y C, l l - I - ► �3 <br />Date of staff site visit: Initials of si e visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />N <br />0 <br />5' <br />0 <br />2 <br />V_ <br />C" <br />ro <br />ao <br />119 <br />C(i <br />_r <br />0 <br />z <br />a <br />Fee Re3so <br />C,�-*3rJay� <br />9J <br />.1-A <br />